Key Differences: Medicare Advantage vs. Medigap

For your well-being and future, choosing health insurance is a critical decision. Fortunately, you've got options when it comes to choosing Medicare.

Additional plans that combine with your Original Medicare are Medicare Advantage (Part C) and Medicare Supplement Plan (Medigap) (parts A and B). They can provide you with the customization you need to meet your specific needs for healthcare.

Both plans are designed to provide benefits that may not be offered by other parts of Medicare. You can not buy both Medicare Advantage and Medigap.

You must choose either Medicare Advantage or Medigap if you want extra benefits from Medicare.

Don't worry if that sounds a bit confusing. Below, we'll explain more.

What is Medicare Advantage Plan?

Medicare Advantage plans, also known as Medicare Part C, are offered by private insurance companies that have been approved by Medicare. These plans provide all of the coverage that is included in traditional Medicare (Parts A and B), as well as additional benefits such as prescription drug coverage, vision, dental, and hearing benefits. Medicare Advantage plans often have lower out-of-pocket costs than traditional Medicare, and many plans have a cap on annual out-of-pocket costs.

For Medicare coverage, Medicare Advantage plans are private insurance options. Such plans cover what Medicare does in the first place, including:

• prescription medications
• Medical
• hospitalization
• Your plan can also cover: depending on which Advantage Plan you choose.
• Gym Membership
• Medical appointments transportation
• Dental
• Vision
• Hearing

To help you find a Medicare Advantage Plan that fits your needs, Medicare.gov has a tool for that.

What is Medicare Supplement Plan?

Medigap, also known as Medicare Supplement Insurance, is private insurance that helps fill the gaps in traditional Medicare coverage. Medigap policies are designed to cover the out-of-pocket costs that Medicare doesn't cover, such as deductibles, copayments, and coinsurance. Medigap policies are only available to people who have Original Medicare (Parts A and B).

A separate set of plans that help offset out-of-pocket expenses and things not otherwise included under the original Medicare plan, such as copayments and coinsurance, is Medicare Supplement, or Medigap.

Newly purchased Medigap plans as of Jan. 1, 2020, do not cover Part B deductibles. In addition to your other Original Medicare benefits, you can buy Medigap (parts A, B, or D).

Do you qualify for Medicare?

To be considered for Medicare Advantage or Medigap plans, there are some conditions you must meet. Here's how you can say whether you qualify for Medicare Advantage or Medicare Supplement:

Medicare Supplement coverage eligibility:

You meet the Medigap coverage requirements of your state.

If you are enrolled in Medicare Parts A and B, you are eligible for Medigap.

1. You are not enrolled in Medicare Advantage.

Medicare Advantage eligibility:

1. Whether you are 65 or older, have disabilities, or have an end-stage renal illness, you are eligible for Medicare Part A and B.
2. If you are enrolled in Medicare Parts A and B, you're eligible for Part C.

Related: Medicare Service in Lakeland,FL

Medicare Advantage plans vs. Medigap

As a part of your Medicare coverage, you can buy Medicare Advantage, or Medicare Part C, from an approved private provider. Each plan's costs are calculated differently.

Cost of Medicare Advantage Plan

Medicare Advantage rates vary across the board, just like any other insurance plan, depending on the insurer you want to register with and the plan you choose.

There's no monthly fee on some plans; some charge several hundred dollars. But you're unlikely to pay more for your Medicare Part C than you're going to pay for your Medicare Part B.

Furthermore, prices such as copays and deductibles may also differ by plan. When evaluating future costs for your Medicare Advantage package, your best bet is to compare plans carefully when you shop.

Using the website Medicare.gov to help compare policies and prices for Medicare Advantage.

Other variables that can impact the cost of plans for Medicare Advantage include:

• your income (this may be used to determine your premium, deductible, and copays amount)
• If you have financial support such as disabilities or Medicaid
• the Advantage plan that you choose
• the number of times you want access to medical care
• where your medical treatment is received (in-network or out-of-network)

Medicare Advantage is a good fit 

You want other covered services, such as hearing, vision, and dental benefits. — For all your insurance needs, you'd better manage one plan.

You've got Medicare parts A, B, and D.

You already have an approved provider that you want, and you know they accept plans for Medicare and Medicare Advantage.

Medicare Advantage doesn't suit you well 

Each year, you want to retain the same provider. (Requirements change annually for licensed providers.) — You want to keep your cost the same. (Rates change on a yearly basis.) — You're thinking about paying for additional coverage that you won't need.

When on Medicare, you fly extensively or intend to. (You must, except for emergencies, live within the coverage area of your plan.)

Medicare Supplement Plan Cost

Again, depending on your eligibility and the type of coverage you choose, each insurance plan varies in price.

For Medicare Supplement plans, the higher the premium, the more coverage you get. Additionally, the older you are, the higher the rate you will have when you enroll.

To help compare Medicare Supplement rates, use the Medicare.gov tool.

Factors that can impact the cost of your coverage for Medigap include:

If you are eligible for a discount (nonsmoker, female, paying electronically, etc.)

your deductibles (a higher deductible plan may cost less)

when your plan was purchased (rules can change, and an older plan may cost less)

Age (the older you are when you apply, the more you may pay)

the plan you're choosing

Medicare Supplement Plan could be a good match for you if:

You need support to cover out-of-pocket costs.

You do have the vision, dental, or hearing coverage you need.

You are going to fly outside the United States and want to be prepared.

You prefer to pick the amount of coverage you buy for out-of-pocket expenditures.

Medicare Supplement might not be a good match for you if:

For extended long-term or hospice treatment, you want coverage.

You don't use a lot of healthcare and usually don't hit the annual deductible.

You already have a plan for Medicare Advantage.

Helping someone to enroll for Medicare?

Enrolling in Medicare can be confusing. There are a few things you can do to make the process smoother if you are helping a friend or family member register.

Here are some tips to assist your loved one with Medicare enrollment:

Prepare your records for Social Security and your loved one's details. They may need to know who you are and your relationship with the person you are helping to enroll.

Speak to your loved one about whether additional coverage such as Medicare Part C or Medigap would be needed.

Explore what their needs are for healthcare and coverage.

Settle on an affordable and practical insurance budget.

Although you can help your loved one assess plans and understand their decisions, unless you have a durable power of attorney for that individual, you can not enroll another person in Medicare. This is a legal document that gives you permission on behalf of another person to make decisions.

Your health is very important.

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